Provider Demographics
NPI:1457659708
Name:COMPREHENSIVEWOUND CARE
Entity Type:Organization
Organization Name:COMPREHENSIVEWOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-706-0174
Mailing Address - Street 1:16515 S 40TH ST
Mailing Address - Street 2:SUITE 139
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0558
Mailing Address - Country:US
Mailing Address - Phone:480-706-0174
Mailing Address - Fax:480-706-0117
Practice Address - Street 1:13203 N 103RD AVE
Practice Address - Street 2:SUITE 1-10
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3028
Practice Address - Country:US
Practice Address - Phone:480-706-0174
Practice Address - Fax:480-706-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33442083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1740489251Other1740489251